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Abstract: PO2120

The Combined Prognostic Significance of Red Blood Cell Distribution Width and Vascular Calcification in Patients with ESKD

Session Information

Category: Hypertension and CVD

  • 1402 Hypertension and CVD: Clinical, Outcomes, and Trials

Authors

  • Kim, Da won, Catholic University of Korea School of Medicine, Seoul, Seoul, Korea (the Republic of)
  • Kim, Dongryul, Catholic University of Korea School of Medicine, Seoul, Seoul, Korea (the Republic of)
  • Lee, Yeonhee, Catholic University of Korea School of Medicine, Seoul, Seoul, Korea (the Republic of)
  • Shin, Seok Joon, Catholic University of Korea School of Medicine, Seoul, Seoul, Korea (the Republic of)
  • Yoon, Hye Eun, Catholic University of Korea School of Medicine, Seoul, Seoul, Korea (the Republic of)
Background

Red blood cell distribution width (RDW) is a simple parameter that reflects the degree of red blood cell volume variability. Recent evidence has shown that increased RDW is associated with adverse clinical outcomes in end-stage kidney disease (ESKD) patients. Vascular calcification (VC) is another major independent risk factor for mortality among ESKD patients. This study investigated the combined prognostic effect of RDW and VC in ESKD patients starting dialysis.

Methods

We conducted a retrospective observational cohort study of 582 ESKD patients treated at a single center from January 2006 to July 2017. VC was assessed by the aortic calcification index (ACI) using abdominal computed tomography. Patients were divided into four groups based on the median ACI (17.12) and serum RDW value (14.3) as low ACI-low RDW, low ACI-high RDW, high ACI-low RDW, or high ACI-high RDW. The association between RDW and VC on the composite of cardiovascular events (CVEs) and death was investigated.

Results

During a median follow-up of 3.1 years (range, 1.5–5.5 years), 165 (28.3%) CVEs and 126 deaths (21.4%) occurred. The Cox regression analyses showed that the patients with low ACI-high RDW (adjusted hazard ratio, 1.934; 95% confidence interval, 1.185-3.157; P = 0.008) and high ACI-low RDW (adjusted hazard ratio, 1.921; 95% confidence interval, 1.171-3.152; P = 0.01) had a greater risk of the composite endpoint than patients with low ACI-low RDW. Patients with high ACI-high RDW had the greatest risk (adjusted hazard ratio, 2.367; 95% confidence interval, 1.465-3.824; P <0.001). The interaction between ACI and RDW on CVEs and mortality was statistically significant (P =0.043).

Conclusion

In ESKD patients starting dialysis, the combined effect of VC and higher RDW was associated with a higher risk of CVEs and death. Also, high serum RDW amplified the risk associated with VC.